The vastly grown streams of refugees since 2014 are strongly affecting the German health care system. The Nordost Health Science Institute of AOK Nordost, a leading medical benefit fund, has therefore addressed this major issue, since it was founded in 2014. The discussion and feedback after the results of the first Berlin study on migrants were announced during the 12th Berlin State Health Conference in December 2015 made clear that further scientific investigations into the health care aspects of migrants are needed.

Erfahrungen mit medizinischer Versorgung in Deutschland

The second Berlin Study of Migrants is built upon the first, but now comprises two research areas. In the first, the project team, under its leader, Prof. Dr. Zahn, conducted structured native-language interviews to collate the information needs and initial experiences of 109 refugees from Syria, Iran and Iraq who attended integration courses run by bbw e.V. in Berlin since 2015.

In the second research area, the anonymised master and performance data of some 100,000 Turkish migrants of the 1st, 2nd and 3rd generations and 21,000 Syrians insured by the AOK Nordost benefit fund were analysed.

Anzahl KH Fälle pro Kopf im 1. HJ 2016

The most important outcome of the study is the prospect that, if relevant processes remain unchanged, the integration of currently arriving migrants or recent refugees reaching Germany from war zones into the health care system will not succeed or be economically optimised until the third generation. This is the future outlook projected by the results of comparisons between the first, second and third generations of Turkish migrants since the 1970s. The findings are based on the evaluation of extensive routine data stored by AOK Nordost on medical diagnoses, hospital treatments, volumes of effective pharmaceutical agents and medical benefit claims. The data was compared with those of persons with no migrant background who were selected by perfect matching methods.

The Turkish migrants who arrived in Berlin in the 1970s today claim considerably more benefits in their working life (2nd generation) and in advanced years (1st generation) than comparable fund members without a migration background.

1st Generation Turkish migrants are 60 years and older today. They use sickness and nursing benefits considerably more frequently than their comparable counterparts. They are (seriously) ill more often, receive more active pharmaceutical agents and spend more time in hospital. The results of the metabolic syndrome which is evidently widespread in this population are particularly noticeable.

verordnete Wirkstoffmengen pro Kopf im 1. HJ 2016

The second generation of Turkish migrants, who usually arrived as children in the 1970s, likewise benefit more from the legally required health insurance (GKV) system than their German counterparts. Only third-generation Turkish residents receive benefit levels comparable to those of German GKV beneficiaries.

The empirical data obtained here show that the integration of Turkish migrants into the German health care system was achieved only in the third generation of German-born Turkish youngsters.

The results of interviews with only recently arrived refugees show that the migrants who have arrived from Syria since 2014 currently still claim considerably less support than comparable medical benefit fund members with no migratory background. Psychic illnesses have not yet surfaced to the previously feared extent; instead, pregnancies and related complications occur relatively frequently.

Anzahl KH Fälle pro Kopf im 1. HJ 2016

Their benefit claims can be expected to rise in their subsequent working years and advancing age, as with the Turkish migrants, and these will outstrip those of their comparable German fund members.

The actors in the health care sector would be well advised to learn from the problems and developments encountered among Turkish immigrants and find innovative ways to integrate the Syrian migrants. If their integration fails or is considerably delayed - as with the Turkish migrants - the health care system would be saddled with considerable extra costs for the next 20 to 50 years.